X-RAY

Question 1

What could cause unilateral pleural effusion?

Answer 1

1. Infection
2. Neoplasm (mesothelioma)
3. Rheumatoid arthritis
4. Autoimmune disease
5. Pancreatitis
6. Haemothorax

Question 2

What is a silhouette sign and when is it seen?

Answer 2

When you lose a margin because adjacent structures have the same density

Pneumonia

Question 3

What is a sail sign?

Answer 3

Shadow behind the heart resembling a sail

Left lower lobe collapse

Question 4

What is a luftischel?

Answer 4

Air crescent around the aortic knuckle

Left upper lobe collapse

Question 5

When do you see a veil-like opacification of the lung?

Answer 5

Left upper lobe collapse

Question 6

When do you commonly see a meniscus sign?

Answer 6

Pleural effusion

Question 7

When do you get a very straight fluid level?

Answer 7

Hydropneumothorax

Question 8

What are the characteristics of left heart failure?

Answer 8

• Batwing pulmonary oedema
• Cardiomegaly
• Kerley B lines
• Dilated upper lobe vessels
• Pleural effusion

Question 9

What would a large supraclavicular tumour and rib erosions be a sign of?

Answer 9

Pancoast tumour (lung cancer at apex)

Question 10

What does pneumothorax look like on x-ray?

Answer 10

• Lung margin coming away from the edge of the ribs
• Slight tracheal deviation
• Shifted heart border

Question 11

What are the loops around the small bowel called?

Answer 11

Valvula conniventes (go all the way across)

Question 12

What are the loops around the large bowel called?

Answer 12

Haustra (only go part of the way across)

Question 13

What is a coffee bean on an AXR?

Answer 13

Sigmoid volvolus - sigmoid colon twists on the sigmoid mesocolon

Question 14

You can’t see fluid filled loops on an X-ray, but if you saw them on CT, what would you suspect?

Answer 14

Diverticular disease - fluid collecting in pouches

Question 15

If you see a dilated large bowel, with loss of haustra, on X-ray and a history of antibiotics what do you suspect clinically?

Answer 15

Toxic megacolon, from c. diff

Question 16

What is thumb printing?

Answer 16

A sign of thickened bowel wall, usually due to Crohn’s disease

Question 17

What is free sub diaphragmatic gas caused by?

Answer 17

Acute perforation (although this could be a sign of recent laparoscopy so important to check in the notes)

Question 18

What is Chilaidit’s Syndrome?

Answer 18

Interposition of the colon between the liver and diaphragm with associated abdo pain.

It causes pseudopneumoperitoneum - look for haustra to reassure you that gas is contained and not free

Question 19

What is Rigler’s sign?

Answer 19

(AKA double wall sign)

Abnormally well-defined bowel wall, due to perforation and pneumoperitoneum

Question 20

What is the 1st line imagine for gallstones/kidney stones?

Answer 20

Ultrasound

Question 21

What are the indications for abdominal CT?

Answer 21

• Complications (perforations, abscess etc)

- Cancer staging

Question 22

What are ERCP and MRCP?

Answer 22

ERCP - Endoscopic retrograde cholangiopancreatography (invasive)
MRCP - Magnetic resonance cholangiopancreatography (non-invasive)

They are used in biliary pathogenesis

Question 23

What are the normal diameters for the small bowel, large bowel and caecum?

Answer 23

3 cm for small bowel
6 cm for colon (large bowel)
9 cm for caecum

This is often referred to as the ‘3/6/9 rule’

Question 24

What are the features of IBD on AXR?

Answer 24

Thumb-printing – mucosal thickening of the haustra due to inflammation and oedema causing them to appear like thumb prints projecting into the lumen

Lead-pipe (featureless) colon – loss of normal haustral markings secondary to chronic colitis

Toxic megacolon – colonic dilatation without obstruction associated with colitis